Simonet Matthieu, Dominguez Gutierrez Ana, Territo Angelo, Prudhomme Thomas, Campi Ricardo, Andras Iulia, Baboudjian Michael, Hevia Vital, Boissier Romain
Department of Urology and Renal Transplantation, Urology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
Urology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
World J Urol. 2022 Dec;40(12):2901-2910. doi: 10.1007/s00345-022-04188-9. Epub 2022 Nov 11.
Urothelial carcinoma has a higher incidence in renal transplanted patients according to several registries (relative risk × 3), and the global prognosis is inferior to the general population. The potential impact of immunosuppressive therapy on the feasibility, efficacy, and complications of endovesical treatment, especially Bacillus Calmette-Guerin, has a low level of evidence. We performed a systematic review that aimed to assess the morbidity and oncological outcomes of adjuvant endovesical treatment in solid organ transplanted patients.
Medline was searched up to December 2021 for all relevant publications reporting oncologic outcomes of endovesical treatment in solid organ transplanted patients with NMIBC. Data were synthesized in light of methodological and clinical heterogeneity.
Twenty-three retrospective studies enrolling 238 patients were included: 206 (96%) kidney transplants, 5 (2%) liver transplants, and 2 (1%) heart transplants. Concerning staging: 25% were pTa, 62% were pT1, and 22% were CIS. 140/238 (59%) patients did not receive adjuvant treatment, 50/238 (21%) received mitomycin C, 4/238 (2%) received epirubicin, and 46/238 (19%) received BCG. Disease-free survival reached 35% with TURBT only vs. 47% with endovesical treatment (Chi-square test p = 0.08 OR 1.2 [0.98-1.53]). The complication rate of endovesical treatment was 12% and was all minor (Clavien-Dindo I).
In solid organ transplanted patients under immunosuppressive treatment, both endovesical chemotherapy and BCG are safe, but the level of evidence concerning efficacy in comparison with the general population is low. According to these results, adjuvant treatment should be proposed for NMIC in transplanted patients as in the general population.
根据多个登记处的数据，尿路上皮癌在肾移植患者中的发病率较高（相对风险×3），总体预后较普通人群差。免疫抑制治疗对膀胱内治疗（尤其是卡介苗）的可行性、疗效及并发症的潜在影响，证据水平较低。我们进行了一项系统评价，旨在评估实体器官移植患者辅助膀胱内治疗的发病率和肿瘤学结局。
检索截至2021年12月的Medline，查找所有报告实体器官移植的非肌层浸润性膀胱癌患者膀胱内治疗肿瘤学结局的相关出版物。根据方法学和临床异质性对数据进行综合分析。
纳入了23项回顾性研究，共238例患者：206例（96%）为肾移植，5例（2%）为肝移植，2例（1%）为心脏移植。关于分期：25%为pTa，62%为pT1，22%为原位癌。140/238例（59%）患者未接受辅助治疗，50/238例（21%）接受丝裂霉素C，4/238例（2%）接受表柔比星，46/238例（19%）接受卡介苗。单纯经尿道膀胱肿瘤电切术的无病生存率为35%，膀胱内治疗为47%（卡方检验p = 0.08，OR 1.2 [0.98 - 1.53]）。膀胱内治疗的并发症发生率为12%，均为轻微并发症（Clavien-Dindo I级）。
在接受免疫抑制治疗的实体器官移植患者中，膀胱内化疗和卡介苗均安全，但与普通人群相比，疗效方面的证据水平较低。根据这些结果，对于移植患者的非肌层浸润性膀胱癌，应如普通人群一样建议进行辅助治疗。
